England scrum-half Alex Mitchell’s availability for the autumn Tests looks under increasing threat as he continues his battle to overcome a neck problem.

Northampton boss Phil Dowson says that Mitchell is “improving very slowly”.

But he has not played this season, and there appears no immediate prospect of him returning to action.

England kick off their autumn campaign against New Zealand on November 2, followed by appointments with Australia, South Africa and Japan.

Mitchell, who has won 18 caps, is currently England’s clear first-choice number nine.

England head coach Steve Borthwick announces his autumn squad on Wednesday, with Bath captain Ben Spencer, who provided bench cover for Mitchell during both summer Tests against the All Blacks, Bristol’s Harry Randall and Leicester scrum-half Jack van Poortvliet all set to be included.

“He (Mitchell) had an injection, and we are waiting to see how effective that has been,” Dowson said.

“So as frustrating as it is, and there are lots of questions around it, there isn’t a definitive timeline because people are reticent to do anything more invasive.

“So basically, a conservative approach is the best approach. Unfortunately, that is one without a timeline.

“We are sort of sat on our hands a little bit, waiting to see how he is. He is improving, but he is improving very slowly, and it is how we can accelerate that process without risking anything from a long-term point of view.

“I want to make sure that he’s not stressed about it, which he doesn’t seem to be. He is a bit frustrated, but we want to make sure we do the right thing by him personally.”

Borthwick has the final say on all medical and sport science matters affecting those England players given ‘hybrid contracts’.

As part of an eight-year Professional Game Partnership announced by the Rugby Football Union, Premiership Rugby and Rugby Players’ Association, Borthwick will have freedom to select up to 25 players who will be paid as much as £160,000 annually in return for greater control of how they are managed on club duty, which includes deciding on medical issues such as when a player undergoes surgery.

Dowson added: “The (England) medics might want to have a look at him, so they might call him in and they might do that on an ad hoc basis or they might do that formally. That’s really up to Steve.

“The fact he hasn’t played for quite a period of time, and it is very slow, I can’t see that turning around in the short term.

“But at the same time they might want to monitor him, they might want to keep him close to the group, they might want to have him ready in there as Joe El-Abd (new defence coach) comes in and there is a change from a coaching point of view to make sure he is up to speed.

“So there are loads of reasons why I would see him in there, and I could also see why they would potentially give him time to stay at home. That’s a decision for Steve.

“The medics have been in constant communication, and they have got the note-taking system so they can see what treatment he has had, when he’s had it, what the specialist has said, what the scans say. They are aware of all the information like we are, and like we are, waiting to see the best route moving forward, really.”

Sale Sharks fly-half George Ford, meanwhile, is continuing his recovery from a torn thigh muscle and could be fit ahead of the autumn games.

Ford was injured during Sale’s Gallagher Premiership defeat at Saracens in late September, although surgery was subsequently not required.

Sharks rugby director Alex Sanderson said that Ford will not be available for the Premiership encounter against Northampton on Friday, but he is set to train next week.